Medical Ultrasonic Cauterization and Cutting Device and Method

ABSTRACT

A method of surgically cutting tissue with an ultrasonic instrument that comprises an ultrasonic waveguide that is movable along a longitudinal extent of the ultrasonic instrument comprises the steps of temporarily compressing tissue between two opposing jaws disposed at a distal end of the ultrasonic instrument, applying a resonant ultrasonic wave to the ultrasonic waveguide, and moving the ultrasonic waveguide in a distal direction along the longitudinal extent to advance the ultrasonic waveguide between at least a portion of the jaws to cut and seal the tissue temporarily secured between the jaws.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/971,329, filed on Dec. 16, 2015, which: is a continuation of U.S.patent application Ser. No. 12/534,030, filed on Jul. 31, 2009, now U.S.Pat. No. 9,247,953 (which application claims priority to U.S.Provisional Application Ser. No. 61/085,688, filed on Aug. 1, 2008), theentire disclosures of which are hereby incorporated herein by referencein their entireties.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable

FIELD OF THE INVENTION

The present systems and methods lies in the field of surgical devices.The present disclosure relates generally to an ultrasonic cutting deviceand, more particularly, relates to a surgical cutting device withvessel-grasping jaws and an extendable blade-shaped ultrasonic cuttingand cauterizing waveguide.

BACKGROUND OF THE INVENTION

Ultrasonic instruments are effectively used in the treatment of manymedical conditions. Cutting instruments that utilize ultrasonic wavesemploy an ultrasonic transducer to generate vibrations along alongitudinal axis of a cutting blade. By placing a resonant wave alongthe length of the blade, high-speed longitudinal mechanical movement isproduced at the blade's end. These instruments are advantageous becausethe mechanical vibrations transmitted to the end of the blade are veryeffective at cutting organic tissue and, simultaneously, at generatingheat sufficient to cauterize the tissue. Such instruments areparticularly well suited for use in minimally invasive procedures, suchas endoscopic or laparoscopic procedures, where the blade is passedthrough a trocar to reach the surgical site.

Physical limitations of known materials used for ultrasonic generatorsand waveguides limit the speed and size of waveforms used to produce theultrasonic movement. These limitations define a finite length at the endof the waveguide, referred to as a “hot spot,” that can effectively beused to perform the cutting and hemostasis. Tissue touching thewaveguide at a particular distance away from the end of the waveguide(outside the hot spot) may be cut, but will not receive enough movementenergy to generate the necessary heat to cause hemostasis. Whenperforming endoscopic or laparoscopic surgery, hemostasis is criticalbecause, where the bleeding is not kept under control, the non-invasivelaparoscopy must be abandoned and the patient's body cut open to performsurgery on the otherwise inaccessible bleeding area.

Vessels are of particular import when performing ultrasonic surgery.Once severed, a vessel must be properly sealed to prevent dangeroushigh-volume blood loss by the patient. Vessels of smaller diameters areable to fall entirely within the hot spot of an ultrasonic cuttingblade, resulting in a precise cut and complete sealing of the two openends of the newly cut vessel. However, larger vessels, such as thosewith a diameter greater than 7 mm, exceed the width of the hotspot atthe end of prior-art blades. This is especially true when the vessel isclamped and flattens out to around 11 mm.

Several devices exist that allow for simultaneous or substantiallysimultaneous cutting and sealing of large-diameter vessels. One suchdevice 100, shown in FIG. 1, for example, is a bipolar electrocauteryvessel sealer that has jaws 102, 104 which clamp across the vessel to besealed. The clamping approximates the opposing walls of the vesselclosely, providing a coaptive force. An open slot 106 runs down themiddle of the jaws 102, 104 allowing a knife 108 to translate from theproximal end 110 of the jaws 102, 104 to the distal end 112 of the jaws102, 104. The sealing process is as follows: The jaws 102, 104 areclamped across the vessel to be sealed. Bipolar (each of the jaws is apole) electrocautery energy is applied to the clamped area of tissue.The energy heats and cauterizes the tissue causing it to become sealedtogether through the coaptive clamping forces of the jaws. Once theenergy has been applied, the knife 108 is translated through the slot106 in the middle of the jaws 102, 104 thus dividing the sealed vesselin the middle of the sealed area.

Another prior-art device for cutting tissue with an ultrasonic cuttingblade is shown in FIG. 2. The ultrasonic clamping and cutting device 200utilizes a clamp 202 having a set of jaws 204, 206 to clamp tissue in aparticular area. Once the tissue is compressed to the point that bloodcan no longer flow into the clamped areas (i.e., hemostasis), ultrasonicmovement is applied through a shaft 212 to an ultrasonic cutting blade208. The blade moves relative to the jaws 204, 206 to pass through theclamped tissue. High-speed “sawing” movement of the blade 208immediately slices through the tissue. The friction of the high-speedblade 208 is intended to also create frictional heat, which heat causesthe tissue on either side of the cut to cauterize.

However, the prior-art instrument shown in FIG. 2 has a significant gap210 around the cutting blade 208. The gap 210 is necessary in thisdevice to allow the moving blade 208 to slide between the jaws 206. Ifthis device were used on a vessel, it would not provide coaptive forcesto opposing walls of the vessel as it translates and cuts. Closecoaption of tissue while the ultrasonic energy is applied is criticalwhen sealing a vessel using ultrasonic energy. Without this coaptiveforce holding the opposing walls of the vessel tightly together duringthe application of the ultrasonic energy, the opposing walls of thevessel will not seal together. Once the blade 208 cuts through thevessel, the gap 210 allows the vessel to pull away from the blade 208,often before the vessel is heated by the blade 208 and properly sealed.Naturally, as the diameter of the vessel being cut increases, thishemostasis problem is exacerbated.

Therefore, a need exists to overcome the problems associated with theprior art, for example, those discussed above.

Thus, a need exists to overcome the problems with the prior art systems,designs, and processes as discussed above.

SUMMARY OF THE INVENTION

Briefly, in accordance with exemplary embodiments of the presentinvention, an ultrasonic surgical instrument includes a shaft having aproximal end and a distal end. A lower jaw has a proximal end and adistal end. The distal end of the shaft terminates into the proximal endof the lower jaw and the lower jaw has an internal trough running fromand through the proximal end and terminating at a point prior to thedistal end of the lower jaw, an upper surface, and a plurality of teethdisposed on the upper surface of the lower jaw on either side of thetrough and at the distal end of the lower jaw. The instrument alsoincludes a pivotable upper jaw with a lower surface facing the uppersurface of the lower jaw and a plurality of teeth disposed on the lowersurface. The instrument further includes an ultrasonic waveguideextending in a direction through the shaft and into the trough. Thewaveguide has a blade with a distal end, a proximal end, and a tissuecompressing and cutting surface upwardly sloping from the distal end ofthe blade to the proximal end of the blade. The jaws are operable tocompress tissue therebetween and the blade is operable to slide withinthe trough to further compress and, then, cut the compressed tissue asthe blade moves from the proximal end of the lower jaw to the distal endof the lower jaw.

In accordance with a further feature of the invention, a sheathsurrounds the waveguide, the first jaw has a first pivot and second jawhas a second pivot and the sheath is coupled to either the first pivotor the second pivot and is operable to move relative to the waveguideand cause the second jaw to move relative to the first jaw.

In accordance with an added feature of the invention, the shaft, thefirst jaw, the second jaw, and the ultrasonic waveguide form atranslating ultrasonic vessel sealer.

In accordance with an additional feature of the invention, there isprovided a ramp in the second jaw and a first protrusion extending fromthe waveguide, the first protrusion sized to engage with the ramp andplace a closing force on the second jaw.

In accordance with yet another feature of the invention, there isprovided a flat portion at an end of the ramp, the flat portion beingsubstantially parallel to a longitudinal axis of the waveguide when thesecond jaw is in a closed position.

In accordance with yet a further feature of the invention, the firstprotrusion has an I-beam shape.

In accordance with yet an added feature of the invention, there isprovided a second protrusion extending from the waveguide on a sideopposite the first protrusion.

In accordance with yet an additional feature of the invention at leastone of the first jaw and the second jaw is biased to an open position.

With the objects of the invention in view, there is also provided anultrasonic surgical instrument having a shaft having a proximal end anda distal end. An upper jaw and a lower jaw each have a proximal end anda distal end with the distal end of the shaft terminating at theproximal end of the upper and lower jaws. Either the upper jaw or thelower jaw are pivotable and at least one of the jaws has an internaltrough running from and through the proximal end of the jaw andterminates at a point prior to the distal end of the jaw. An ultrasonicwaveguide extends in a direction through the shaft and into the troughand has a blade, where the blade has a distal end, a proximal end, a topsurface portion, and a tissue compressing surface upwardly sloping fromthe distal end of the blade toward the proximal end of the blade, atleast one of the tissue compressing surface and the top surface portionform a cutting surface wherein the jaws are operable to compress tissuetherebetween and the blade is operable to slide within the trough tofurther compress, seal, and cut the compressed tissue as the blade movesin a direction from the proximal end of the jaw to the distal end of thejaw.

With the objects of the invention in view, there is also provided amethod for performing a surgical procedure, which includes the steps ofproviding a shaft having a proximal end and a distal end, providing afirst jaw having a proximal end and a distal end, the distal end of theshaft terminating at the proximal end of the first jaw, the first jawhaving an internal trough running from and through the proximal end ofthe first jaw and terminating at a point prior to the distal end of thefirst jaw and a surface having a plurality of teeth on either side ofthe trough and at the distal end of the first jaw. The method furtherincludes providing a second jaw having a surface facing the surface ofthe first jaw and having a plurality of teeth thereat and providing anultrasonic waveguide extending beyond the shaft and being slidablyengagable with the trough, the ultrasonic waveguide having a distal end,a proximal end, a top surface portion, and a tissue compressing surfaceupwardly sloping from the distal end of the ultrasonic waveguide towardthe proximal end of the ultrasonic waveguide, at least one of the tissuecompressing surface and the top surface portion forming a cuttingsurface. The method also includes the steps of compressing tissuebetween the jaws, applying an ultrasonic wave to the ultrasonicwaveguide, and sliding the ultrasonic waveguide within the trough in adirection from the proximal end of the lower jaw to the distal end ofthe lower jaw to further compress and cut the compressed tissue.

With the objects of the invention in view, there is also provided anultrasonic surgical instrument includes a shaft, a first jaw having aproximal end at the distal end of the shaft, a second jaw and anultrasonic waveguide. The first jaw has an internal trough runningthrough the proximal end of the first jaw and a surface on either sideof the trough. The second jaw has a surface facing the surface of thefirst jaw. The waveguide extends beyond the shaft and slidably engagesthe trough and has a blade with a tissue compressing surface upwardlysloping proximally from a distal end thereof the blade and having anupper portion and a substantially horizontal top surface portion at theupper portion. The tissue compressing surface and/or the top surfaceportion forms a cutting surface. When the jaws compress tissuetherebetween, the blade slides within the trough to further compress andcut the compressed tissue as the blade moves distally.

With the foregoing and other objects in view, there is provided, amethod of surgically cutting tissue with an ultrasonic instrument thatcomprises an ultrasonic waveguide that is movable along a longitudinalextent of the ultrasonic instrument comprising the steps of compressingtissue between two opposing jaws disposed at a distal end of theultrasonic instrument, applying a resonant ultrasonic wave to theultrasonic waveguide, and moving the ultrasonic waveguide in a distaldirection along the longitudinal extent to advance the ultrasonicwaveguide between at least a portion of the jaws to cut and seal thetissue temporarily secured between the jaws.

With the objects in view, there is also provided a method of surgicallycutting tissue with an ultrasonic instrument that comprises anultrasonic waveguide that is movable along a longitudinal extent of theultrasonic instrument comprises the steps of applying a resonantultrasonic wave to the ultrasonic waveguide and moving the ultrasonicwaveguide in a distal direction to convert two opposing jaws disposed ata distal end of the ultrasonic instrument from an open position to aclosed position to compress tissue between the jaws and to advance theultrasonic waveguide between at least a portion of the closed jaws tocut and seal the tissue compressed between the jaws.

In accordance with another mode, the ultrasonic instrument comprises ahollow shaft having an internal lumen that defines a longitudinal axisand the ultrasonic waveguide is slidably disposed within the internallumen of the shaft and is advanceable in the distal direction andretractable in a proximal direction parallel to the longitudinal axis.

In accordance with a further mode, the shaft has a proximal end and theultrasonic instrument further comprises a handle body at the proximalend of the shaft, the handle body comprising a movement mechanismconfigured to advance and retract the ultrasonic waveguide along thelongitudinal extent of the ultrasonic instrument.

In accordance with an added mode, the two opposing jaws comprise a firstjaw fixed parallel to the longitudinal axis and a second jaw pivotallyconnected to the shaft and movable between open and closed positionswith respect to the first jaw such that compressing the tissue betweenthe two opposing jaws comprises pivoting the second jaw towards thefirst jaw to move from the open position to the closed position.

In accordance with an additional mode, the first jaw is one of fixedlyconnected to the shaft and integral with the shaft.

In accordance with yet another mode, the ultrasonic waveguide has adistal blade, the first jaw has a distal end defining a trough partiallyexposing the lumen to the environment, and which further comprisesadvancing the ultrasonic waveguide between at least a portion of the twoopposing jaws extends the distal blade into the trough.

In accordance with yet a further mode, the distal blade has proximal anddistal ends, a tissue compressing surface sloping upwardly from thedistal end of the blade towards the proximal end of the blade and havingan upper portion, and a substantially horizontal top surface at theupper portion, at least one of the tissue compressing surface and thetop surface forming a cutting surface, and, responsive to thecompressing of the tissue between the two opposing jaws and theadvancing of the ultrasonic waveguide between at least a portion of thejaws and into the trough, the distal blade further compresses and cutsthe compressed tissue.

In accordance with yet an added mode, the second jaw is connected to theshaft by at least one pivot and the ultrasonic instrument furthercomprises a sheath surrounding the shaft and operatively connected tothe at least one pivot, the sheath being configured to move relative tothe shaft in the distal direction to cause the second jaw to move aboutthe pivot towards the first jaw to assume the closed position.

In accordance with yet an additional mode, the movement mechanism of thehandle body comprises a trigger assembly operatively connected to theultrasonic waveguide.

In accordance with again another mode, the handle body further comprisesan ultrasonic transducer operatively coupled to the ultrasonic waveguideto impart the resonant wave to the waveguide when activated and abattery configured to activate the ultrasonic transducer.

In accordance with again a further mode, the two opposing jaws comprisea first jaw fixed parallel to the longitudinal axis and a second jawpivotally connected to the shaft and movable with respect to the firstjaw such that converting the jaws from the open position to the closedposition comprises pivoting the second jaw towards the first jaw.

In accordance with again an added mode, the second jaw has a ramptherein and the ultrasonic waveguide has an upwardly-extendingprotrusion that is sized to engage with the ramp and place a closingforce on the second jaw as the ultrasonic waveguide moves in the distaldirection.

In accordance with again an additional mode, the protrusion has anI-beam shape.

In accordance with a concomitant mode, the movement mechanism of thehandle body comprises a trigger assembly operatively connected to theultrasonic waveguide.

Although the systems and methods are illustrated and described herein asembodied in a medical ultrasonic cauterization and cutting device andmethod, it is, nevertheless, not intended to be limited to the detailsshown because various modifications and structural changes may be madetherein without departing from the spirit of the invention and withinthe scope and range of equivalents of the claims. Additionally,well-known elements of exemplary embodiments will not be described indetail or will be omitted so as not to obscure the relevant details ofthe systems and methods.

Additional advantages and other features characteristic of the systemsand methods will be set forth in the detailed description that followsand may be apparent from the detailed description or may be learned bypractice of exemplary embodiments. Still other advantages of the systemsand methods may be realized by any of the instrumentalities, methods, orcombinations particularly pointed out in the claims.

Other features that are considered as characteristic for the systems andmethods are set forth in the appended claims. As required, detailedembodiments of the systems and methods are disclosed herein; however, itis to be understood that the disclosed embodiments are merely exemplaryof the systems and methods, which can be embodied in various forms.Therefore, specific structural and functional details disclosed hereinare not to be interpreted as limiting, but merely as a basis for theclaims and as a representative basis for teaching one of ordinary skillin the art to variously employ the systems and methods in virtually anyappropriately detailed structure. Further, the terms and phrases usedherein are not intended to be limiting; but rather, to provide anunderstandable description of the systems and methods. While thespecification concludes with claims defining the systems and methods ofthe invention that are regarded as novel, it is believed that thesystems and methods will be better understood from a consideration ofthe following description in conjunction with the drawing figures, inwhich like reference numerals are carried forward.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying figures, where like reference numerals refer toidentical or functionally similar elements throughout the separateviews, which are not true to scale, and which, together with thedetailed description below, are incorporated in and form part of thespecification, serve to illustrate further various embodiments and toexplain various principles and advantages all in accordance with thesystems and methods. Advantages of embodiments of the systems andmethods will be apparent from the following detailed description of theexemplary embodiments thereof, which description should be considered inconjunction with the accompanying drawings in which:

FIG. 1 is a fragmentary, perspective view of a prior-art surgicalstapler-cutter.

FIG. 2 is a fragmentary, perspective view of a prior-art ultrasoniccutting device.

FIG. 3 is a fragmentary, perspective view of an ultrasonic cutting andcauterizing device in accordance with an exemplary embodiment of thepresent invention with the jaws in an open position and a waveguide in aretracted position within a trough in a lower jaw.

FIG. 4 is a fragmentary, perspective view of the ultrasonic cutting andcauterizing device of FIG. 3 with the jaws in a clamping position andthe waveguide in an extended position.

FIG. 5 is a perspective view of the ultrasonic cutting and cauterizingdevice of FIG. 3 with the jaws in an open position and the waveguide inan intermediate position.

FIG. 6 is a perspective view of the ultrasonic cutting and cauterizingdevice of FIG. 3 with the jaws in an open position and the waveguide ina fully extended position.

FIG. 7 is a diagrammatic illustration of the effect that a resonantdriving wave input to a transducer has on a waveguide of the ultrasoniccutting device in accordance with an exemplary embodiment of the presentinvention with an exaggerated sinusoidal pattern shown representing theamplitude of axial motion along the length of the waveguide.

FIG. 8 is a fragmentary, perspective view of the ultrasonic cutting andcauterizing device of FIG. 3 with an alternative waveguide shape inaccordance with an exemplary embodiment of the present invention.

FIG. 9 is a fragmentary, perspective view of the ultrasonic cutting andcauterizing device of FIG. 3 with a second alternative waveguide shapein accordance with an exemplary embodiment of the present invention.

FIG. 10 is an elevational view of a surgical handle attached to anultrasonic cutting and cauterizing device in accordance with anexemplary embodiment of the present invention.

FIG. 11 is a fragmentary, perspective view of an ultrasonic cutting andcauterizing device with an I-beam waveguide in a retracted position inaccordance with an exemplary embodiment of the present invention.

FIG. 12 is a fragmentary, perspective view of the ultrasonic cutting andcauterizing device of FIG. 11 with the jaws in an open position and awaveguide in a partially extended position within a trough in a lowerjaw.

FIG. 13 is a fragmentary, perspective view of the ultrasonic cutting andcauterizing device of FIG. 11 with the jaws in a clamped position andthe waveguide in an intermediate position.

FIG. 14 is a partially transparent, perspective view of the ultrasoniccutting and cauterizing device of FIG. 13.

FIG. 15 is a process flow diagram of an exemplary process of operatingan ultrasonic cutting and cauterizing device in accordance with anembodiment of the present invention.

DETAILED DESCRIPTION OF THE EMBODIMENTS

As required, detailed embodiments of the systems and methods aredisclosed herein; however, it is to be understood that the disclosedembodiments are merely exemplary of the systems and methods, which canbe embodied in various forms. Therefore, specific structural andfunctional details disclosed herein are not to be interpreted aslimiting, but merely as a basis for the claims and as a representativebasis for teaching one skilled in the art to variously employ thesystems and methods in virtually any appropriately detailed structure.Further, the terms and phrases used herein are not intended to belimiting; but rather, to provide an understandable description of thesystems and methods. While the specification concludes with claimsdefining the features of the systems and methods that are regarded asnovel, it is believed that the systems and methods will be betterunderstood from a consideration of the following description inconjunction with the drawing figures, in which like reference numeralsare carried forward.

In the following detailed description, reference is made to theaccompanying drawings which form a part hereof, and in which are shownby way of illustration embodiments that may be practiced. It is to beunderstood that other embodiments may be utilized and structural orlogical changes may be made without departing from the scope. Therefore,the following detailed description is not to be taken in a limitingsense, and the scope of embodiments is defined by the appended claimsand their equivalents.

Alternate embodiments may be devised without departing from the spiritor the scope of the invention. Additionally, well-known elements ofexemplary embodiments of the systems and methods will not be describedin detail or will be omitted so as not to obscure the relevant detailsof the systems and methods.

Before the systems and methods are disclosed and described, it is to beunderstood that the terminology used herein is for the purpose ofdescribing particular embodiments only and is not intended to belimiting. The terms “comprises,” “comprising,” or any other variationthereof are intended to cover a non-exclusive inclusion, such that aprocess, method, article, or apparatus that comprises a list of elementsdoes not include only those elements but may include other elements notexpressly listed or inherent to such process, method, article, orapparatus. An element proceeded by “comprises . . . a” does not, withoutmore constraints, preclude the existence of additional identicalelements in the process, method, article, or apparatus that comprisesthe element. The terms “including” and/or “having,” as used herein, aredefined as comprising (i.e., open language). The terms “a” or “an”, asused herein, are defined as one or more than one. The term “plurality,”as used herein, is defined as two or more than two. The term “another,”as used herein, is defined as at least a second or more. The descriptionmay use the terms “embodiment” or “embodiments,” which may each refer toone or more of the same or different embodiments.

The terms “coupled” and “connected,” along with their derivatives, maybe used. It should be understood that these terms are not intended assynonyms for each other. Rather, in particular embodiments, “connected”may be used to indicate that two or more elements are in direct physicalor electrical contact with each other. “Coupled” may mean that two ormore elements are in direct physical or electrical contact (e.g.,directly coupled). However, “coupled” may also mean that two or moreelements are not in direct contact with each other, but yet stillcooperate or interact with each other (e.g., indirectly coupled).

For the purposes of the description, a phrase in the form “A/B” or inthe form “A and/or B” or in the form “at least one of A and B” means(A), (B), or (A and B), where A and B are variables indicating aparticular object or attribute. When used, this phrase is intended toand is hereby defined as a choice of A or B or both A and B, which issimilar to the phrase “and/or”. Where more than two variables arepresent in such a phrase, this phrase is hereby defined as includingonly one of the variables, any one of the variables, any combination ofany of the variables, and all of the variables, for example, a phrase inthe form “at least one of A, B, and C” means (A), (B), (C), (A and B),(A and C), (B and C), or (A, B and C).

Relational terms such as first and second, top and bottom, and the likemay be used solely to distinguish one entity or action from anotherentity or action without necessarily requiring or implying any actualsuch relationship or order between such entities or actions. Thedescription may use perspective-based descriptions such as up/down,back/front, and top/bottom. Such descriptions are merely used tofacilitate the discussion and are not intended to restrict theapplication of disclosed embodiments. Various operations may bedescribed as multiple discrete operations in tum, in a manner that maybe helpful in understanding embodiments; however, the order ofdescription should not be construed to imply that these operations areorder dependent.

As used herein, the term “about” or “approximately” applies to allnumeric values, whether or not explicitly indicated. These termsgenerally refer to a range of numbers that one of skill in the art wouldconsider equivalent to the recited values (i.e., having the samefunction or result). In many instances these terms may include numbersthat are rounded to the nearest significant figure.

It will be appreciated that embodiments of the systems and methodsdescribed herein may be comprised of one or more conventional processorsand unique stored program instructions that control the one or moreprocessors to implement, in conjunction with certain non-processorcircuits and other elements, some, most, or all of the functions of thedevices and methods described herein. The non-processor circuits mayinclude, but are not limited to, signal drivers, clock circuits, powersource circuits, and user input and output elements. Alternatively, someor all functions could be implemented by a state machine that has nostored program instructions, or in one or more application specificintegrated circuits (ASICs) or field-programmable gate arrays (FPGA), inwhich each function or some combinations of certain of the functions areimplemented as custom logic. Of course, a combination of theseapproaches could also be used. Thus, methods and means for thesefunctions have been described herein.

The terms “program,” “software,” “software application,” and the like asused herein, are defined as a sequence of instructions designed forexecution on a computer system or programmable device. A “program,”“software,” “application,” “computer program,” or “software application”may include a subroutine, a function, a procedure, an object method, anobject implementation, an executable application, an applet, a servlet,a source code, an object code, any computer language logic, a sharedlibrary/dynamic load library and/or other sequence of instructionsdesigned for execution on a computer system.

Herein various embodiments of the systems and methods are described. Inmany of the different embodiments, features are similar. Therefore, toavoid redundancy, repetitive description of these similar features maynot be made in some circumstances. It shall be understood, however, thatdescription of a first-appearing feature applies to the later describedsimilar feature and each respective description, therefore, is to beincorporated therein without such repetition.

The present invention, according to one embodiment, overcomes problemswith the prior art by providing a surgical device that is able to clamponto tissue, such as large vessels, to slide a tapered ultrasoniccutting blade within the clamped area of the tissue, thereby providingthe critical coaptive force to opposing vessel walls during the sealingand to ultrasonically cauterizing and sealing the clamped tissue as itis cut.

Ultrasonic Surgical Device

Described now is an exemplary ultrasonic surgical instrument accordingto one embodiment of the present invention. Referring to FIG. 3, theinstrument 300 is shown in a perspective view. The instrument 300includes a shaft 302 with a proximal end (out of view in this diagram)and a distal end 304. The distal end 304 terminates into the proximalend 306 of a lower jaw 308. The lower jaw 308 defines an internal trough310 running from and through the proximal end 306 of the lower jaw 308to a point just before the lower jaw's distal extent 312. The lower jaw308 also includes an upper surface 314 with a plurality of teeth 316disposed on either side of the trough 310 and at the distal end 312 ofthe lower jaw 308.

The instrument 300 also has a pivoting upper jaw 318 with a lowersurface 320 facing or opposing the upper surface 314 of the lower jaw308. A second plurality of teeth 322 is disposed on the lower surface320 of the upper jaw 318. The upper 318 and lower 308 jaws are operableto compress tissue therebetween. The teeth 316, 322, in one exemplaryembodiment, are ridges that help grip the tissue and prevent it fromsliding out from between the closed jaws 308 and 318.

In one embodiment of the present invention, the pivotable upper jaw 318is actuated/activated by a sheath 324 that surrounds and moves relativeto the shaft 302. In the embodiment shown in FIG. 3, the pivoting upperjaw 318 is attached to the shaft 302 at a first point 326 and isattached to the sheath 324 at a second point 328. When the sheath 324 ispushed toward the distal end 304 of the shaft 302, the upper jaw 318pivots around both attachment points 326 and 328 and, as shown in FIG.4, moves toward the lower jaw 308. The position shown in FIG. 4 is afully clamped position of the jaws 308, 318. Of course, the sheath 324is not the only configuration for operating the upper jaw 318. Anymechanical means of moving one of the jaws 308 and 318 relative to theother so that tissue is clamped there between is within the spirit andscope of the present invention. In addition, the shaft 302 and the lowerjaw 308 are not necessarily two separate elements and can be, instead,one continuous piece of material. For example, the sheath 324 can be ahollow body defining two lumens therein, one for the shaft 302 and onefor a non-illustrated actuation rod. That actuation rod can exist withinthe second lumen and distal translation can cause closure of the upperjaw 318.

Referring now to FIG. 5, an inventive sliding ultrasonic waveguide 500is shown within the trough 310. According to embodiments of the presentinvention, the waveguide 500 is able to be moved from a retracted orwithdrawn position, shown in FIG. 3 through any intermediate position(e.g., shown in FIG. 5) to, as will be explained in detail below, afully extended position shown in FIGS. 4 and 6.

Referring briefly to FIG. 7, an ultrasonic transducer 702 is showncoupled to the waveguide 500. This transducer 702 is anelectro-mechanical device that converts electrical signals to physicalmovement. In a broader sense, a transducer is sometimes defined as anydevice that converts a signal from one form to another. An analogoustransducer device is an audio speaker, which converts electrical voltagevariations representing music or speech to mechanical cone vibration.The speaker cone, in turn, vibrates air molecules to create acousticalenergy. In the present invention, a driving wave is input to thetransducer 702, which then imparts physical movements to the waveguide500. As will be shown, this movement sets up a resonating wave on thewaveguide 500, resulting in motion at the end of the waveguide 500.

Responding to a positive portion of the driving wave, the transducer 702moves a portion 704 of the transducer 702, which is physically attachedto a portion 706 of the attached waveguide 500, in a first direction 708Likewise, the transducer 702 responds to a negative portion of thedriving wave and moves the portion 704 of the transducer 702 in a seconddirection 712. One exemplary embodiment of the portion 704 is a stack ofpiezo-electric crystals.

The alternating movement 708, 712 of the transducer portion 704 placesan axial compression/expansion wave illustrated by the sinusoidal wave714 along the length of the waveguide 500. The wave 714 alternativelypulls the end 720 of the waveguide 500 toward the transducer 702 andpushes it away from the transducer 702, thereby longitudinally movingthe tip 720 of the waveguide 500 along distance 718. The tip 720 isconsidered an “anti-node,” as it is a moving point of the sine wave 714.The resulting movement of the waveguide 500 produces a “sawing” movementalong distance 718 at the end of the waveguide 500. (The wave 714 andlinear movement along distance 718 are greatly exaggerated in FIG. 7 forease of discussion.) This high-speed movement along distance 718, as isknown in the art, provides a cutting waveguide that is able to sliceeasily through many materials, such as tissue and bone. The waveguide500 also generates a great deal of frictional heat when so stimulated,which heat is conducted within the tissue that the waveguide 500 iscutting. This heat is sufficient to cauterize blood vessels within thetissue being cut.

Returning now to FIG. 5, the waveguide 500 is shown having an upwardlysloping surface 502 and substantially horizontal surface 504 at an upperportion of the upwardly sloping surface 502. The upwardly slopingsurface 502 further compresses tissue when the tissue is alreadycompressed between the jaws 308, 318. Any sub-portion(s) of the surfaces502, 504 can be the ultrasonic cutting/cautery surface and a frequencyof the driving wave will determine the length of such a cutting/cauterysurface (increasing the frequency decreases this length and decreasingthe frequency increases the length). In one exemplary embodiment, onlythe upwardly sloping surface 502 comprises the cutting/cautery surface.In another exemplary embodiment, both the upwardly sloping surface 502and a portion of the substantially horizontal surface 504 comprises thecutting/cautery surface. If desired, the substantially horizontalsurface 504 can slope upward like the surface 502 but at an angle, e.g.,of about 3-5 degrees.

In FIG. 5, the jaws 308 and 318 are shown in an open position only forthe purpose of illustrating the blade 500 within the trough 310. Inactual operation, the jaws 308 and 318 will not be in the open position,but will, instead, be in the closed position shown in FIG. 4.

The device 300 operates as set forth in the following text. When thewaveguide 500 is in the retracted position, shown in FIG. 3, the device300 is positioned to insert tissue between the jaws 308, 318. The sheath324 is, then, slid forward relative to the shaft 302, causing the jaws308, 318 to clamp down upon the tissue. Preferably, the clamping forcewill be sufficient to blanch blood from the clamped area and preventfurther blood flow to the tissue within the jaws suspended above thetrough 310. Next, the ultrasonically-moving waveguide 500 is extendeddistally along the trough 310. As the waveguide 500 moves distally, thesloped edge 502 of the waveguide 500 forces the tissue up against thebottom surface 320 of the upper jaw 318. This forcing further compressesthe tissue. During or after the further compression of the tissue, thecutting area of at least one of the surfaces 502, 504 contacts thetissue and both cuts and cauterizes it. Because the tissue is highlycompressed, solid physical contact with the ultrasonically movingwaveguide 500, 504 improves heat and movement transferred to the tissueto be cut. Advantageously, because the tissue is compressed by the jaws308, 318 to such a degree, it does not pull away from the waveguide 500and remains in place long enough for hemostasis to occur.

Prior art ultrasonic devices had and have fixed-length cutting surfaces.This means that the prior art devices are limited in the size of vesselsthat can be cut/cauterized. The device 300, in contrast, advantageouslyallows much larger vessels to be cut and cauterized than any devicebefore, even where the hot spot is smaller than the diameter of thevessel to be cut. Using the illustration of FIGS. 3 and 6, for example,cutting of a vessel having a diameter as long as the exposed portion ofthe trough 310 in the figures is possible with the device 300.Furthermore these devices are often used for cutting through sections ofmesentery that contain large quantities of small blood vessels. Having alarge hot spot will allow the surgeon to transect through these areasmore rapidly.

FIG. 8 shows an embodiment 800 of the inventive device that utilizes ablade 802 having a novel shape. The blade 802 is provided with arelatively wide angled blade area 804 at the tip of the blade, whereinitial contact is made with tissue when the blade 802 is ejected outfrom within the interior of the shaft 806. The angled flat portion 804of the blade 802 simultaneously pushes or “scoops” the tissue up towardthe upper jaw 808 and toward a second area of the blade 810 that, in theembodiment shown in FIG. 8, is shaped to a sharp cutting edge. Once thetissue is pushed beyond the flat area 804, the tissue contacts sharpcutting edge 810 and tissue cutting takes place. Advantageously, by thetime the tissue reaches the cutting edge 810, the flat area 804 hasplaced the tissue under pressure. The pressure ensures sufficientcontact between the tissue and the cutting blade 802 to allowcauterization to occur.

FIG. 9 shows a second embodiment of the surgical cutting device of FIG.8. In the embodiment 900 of FIG. 9, the cutting blade 902 has a longer,more gradually sloping (from front to back), flat (less sharp),non-cutting portion 904. The non-cutting portion 904 terminates into acutting portion 906 that is shorter and steeper than the cutting portion810 of FIG. 8. The shorter, steeper portion 906 provides an addedpressurizer of the tissue prior to it moving on to the cutting portion902. However, cutting may also take place on the steeper portion 906.

FIGS. 5, 8, and 9 and a comparison between them show that the presentinvention is not limited to any particular geometry or dimensions ofcutting blades. Many variations are within the spirit and scope of thepresent invention.

FIG. 10 shows an exemplary surgical device 1000 utilizing the inventivecutting and cauterizing waveguide assembly, designated with numeral1001. The surgical device 1000 includes a handle 1002 mechanicallycoupled to and operable to manipulate the waveguide assembly 1001. Thehandle 1002 includes the transducer 702 mechanically coupled to thewaveguide 500, which generates the ultrasonic cutting and cauterizingmotion at the distal end of the waveguide 500. Advantageously, thehandle 1002 includes a spindle 1004 that allows the waveguide assembly1001 and the transducer 702 to rotate relative to the handle 1002, foroperation at a variety of angles.

In one exemplary embodiment of the present invention, power is derivedfrom only a battery 1006, or a group of batteries, small enough to fiteither within the handle 1002 or within a small non-illustrated box thatattaches to the user, for example, at a waistband. State-of-the-artbattery technology provides powerful enough batteries of a fewcentimeters in height and width and a few millimeters in depth toaccomplish this task.

The handle 1002 is provided with a trigger 1008 that, when depressed,causes the blade portion of the waveguide 500 to move distally withinthe trough (not shown in this view) toward a distal end of the jaws 308,318. In another exemplary embodiment, forward movement speed of thewaveguide 500 is limited by a trigger controller 1010, which, in oneexemplary embodiment, slows the maximum possible speed of triggerdepression as trigger pressure increases. Such a trigger controller 1010ensures that the speed of the blade remains within a particular range ifthe surgeon applies force on the trigger 1008 that would cause the blade500 to move faster than acceptable for proper cutting/cauterizing oftissue. The controller 1010 can be any device that can limit a rate ofmovement, such as a fly governor or a dashpot, for example.Alternatively the trigger motion could load a constant force springwhich would drive the blade with a fixed forward pressure. As a result,the blade will move, but will be limited to a maximum velocity, whichwill result in proper sealing of the tissue. In such a case, an audiblealert would be utilized to notify the surgeon that the transection wascomplete.

FIGS. 11-14 show an embodiment of the present invention that utilizeswhat is referred to herein as an “I-beam” blade. Turning first to FIG.11, an ultrasonic surgical cutting and cauterizing assembly 1100 isshown. The assembly 1100 is provided with an upper jaw 1102 and a lowerjaw 1104. Although the jaws shown in the instant specification have beenshown with and described as having a pivoting upper jaw and stationarylower jaw, the invention is not so limited. In other embodiments, thelower jaw can pivot and the upper jaw is stationary or, alternatively,both jaws are able to pivot. Also included in the assembly 1100 of FIG.11 is a shaft 1106 having a proximal end (not shown in FIG. 11) and adistal end 1108. The lower jaw 1104 has a proximal end 1110 and a distalend 1112. The distal end 1108 of the shaft 1106 terminates at theproximal end 1110 of the lower jaw 1104. As in the assembly 300, shownin FIGS. 3-6, the lower jaw 1104 has an internal trough 1114 runningfrom and through the proximal end 1110 of the lower jaw 1104 andterminating at a point prior to the distal end 1112 of the lower jaw1104. The lower jaw 1104 also has an upper surface 1116 that surroundsthe trough on three sides and has a plurality of teeth 1118 thereat. Thepivotable upper jaw 1102 includes a lower surface 1120 facing the uppersurface 1116 of the lower jaw 1104 and has a plurality of teeth 1122thereat.

The transparent view of the sleeve 1124 and shaft 1106 in FIG. 11 showsan ultrasonic waveguide 1126 present and withdrawn into the shaft 1106.The novel waveguide 1126 features a pair of I-beam-shaped protrusions1128 and 1130 extending from opposite sides of the waveguide 1126. Aswill be explained and shown in the following figures, the I-beam-shapedprotrusions 1128 and 1130 automatically close the jaws 1102 and 1104 asthe waveguide 1126 extends from the shaft 1106. This automatic closingof the jaws 1102 and 1104 advantageously eliminates a step from thecutting and cauterizing process performed with the present inventionmaking surgical processes even easier for the surgeon utilizing theinstrument 1100.

FIG. 12 shows a distal end 1202 of the waveguide 1126 extending slightlyout of the distal end 1108 of the shaft 1106. The distal end 1202 of thewaveguide 1126 features a tissue compressing surface 1204 upwardlysloping from the distal end 1202 of the waveguide 1126 to a proximal endof the waveguide 1126 (not shown in FIG. 12). The tissue compressingsurface 1204 terminates into a cutting surface 1206 that is alsoupwardly sloping from the tissue compressing surface 1204 of thewaveguide 1126 to a proximal end of the waveguide 1126 (not shown inFIG. 12).

FIG. 13 illustrates the functionality of the I-beam protrusions 1128 and1130. The view of FIG. 13 shows the jaws 1102 and 1104 in a closed orclamped state. The upper jaw 1102 features a recessed area 1302. Withinthe recessed area 1302 is a ramp 1304, which terminates into a flat area1306. In their natural state, the jaws 1102 and 1104 are biased to anopen position, as shown in FIGS. 11 & 12. As the waveguide 1126continues to be extended out of the shaft 1106, the upper I-beamprotrusion 1130 comes into contact first with the ramp 1304. Althoughnot shown in FIG. 13, the lower jaw 1104 is also provided with arecessed area for engaging the lower I-beam protrusion 1128. The fixeddistance between the I-beam protrusions 1128 and 1130 squeezes the jaws1102 and 1104 together, forcing the upper jaw 1102 to close toward thelower jaw 1104 as the I-beam 1130 is pushed further up the ramp 1304.Once the upper jaw 1102 and lower jaw 1104 are in their fully clampedpositions, as shown in FIG. 13, the upper protrusion of the I-beamfollows the flat portion 1306 of the recess 1302 of the upper jaw 1102.The jaws 1102 and 1104 cannot become unclamped while the I-beamprotrusion is positioned along the flat portion 1306. The I-beamembodiment advantageously results in an automatic clamping of the jaws1102 and 1104 and extension of the cutting waveguide 1120 within thetrough 1114, all in a single step. The operator need only extend thewaveguide 1126 to cause the jaws 1102 and 1104 to compress tissuetherebetween. The waveguide 1126 continues to slide within the trough1302 to further compress and cut the compressed tissue as the waveguide1126 moves in a direction from the proximal end 1110 of the jaws 1102and 1104 to the distal end 1112 of the jaws 1102 and 1104.

As the waveguide 1126 is retracted back into the shaft 1106, the bias onthe jaws 1102 and 1104 forces the jaws 1102 and 1104 to begin opening.Once the I-beam protrusion 1130 is moved beyond the ramp 1304, the jaws1102 and 1104 return to their fully open position, shown in FIGS. 11 and12.

FIG. 14 shows a partially transparent view of the ultrasonic surgicaldevice of FIGS. 11-13. The partially transparent view shows the lowerrecessed area 1402 where the lower protrusion 1128 travels when thewaveguide 1126 is extended out of the shaft 1106.

FIG. 15 shows an exemplary process flow diagram of method of using anembodiment of the present invention. In a first step 1502, the operatorcloses the jaws 1102 and 1104 to compress tissue between them. Next, instep 1504, the ultrasonic transducer 702 applies an ultrasonic wave tothe ultrasonic waveguide 500. In a following step, 1506, the bladeportion 902, 904, 906 is slid within the trough 310 in a direction fromthe proximal end of the lower jaw to the distal end of the lower jaw tofurther compress and cut the already partially compressed tissue. Oncestep 1506 is complete, the blade, in step 1508, is retracted and, instep 1510, the jaws are opened and the tissue released. The process endsat step 1512.

Although specific embodiments of the invention have been disclosed,those having ordinary skill in the art will understand that changes canbe made to the specific embodiments without departing from the spiritand scope of the invention. The scope of the invention is not to berestricted, therefore, to the specific embodiments, and it is intendedthat the appended claims cover any and all such applications,modifications, and embodiments within the scope of the presentinvention.

The terms “a” or “an”, as used herein, are defined as one or more thanone. The term plurality, as used herein, is defined as two or more thantwo. The term another, as used herein, is defined as at least a secondor more. The terms including and/or having, as used herein, are definedas comprising (i.e., open language). The term coupled, as used herein,is defined as connected, although not necessarily directly, and notnecessarily mechanically.

It is noted that various individual features of the inventive processesand systems may be described only in one exemplary embodiment herein.The particular choice for description herein with regard to a singleexemplary embodiment is not to be taken as a limitation that theparticular feature is only applicable to the embodiment in which it isdescribed. All features described herein are equally applicable to,additive, or interchangeable with any or all of the other exemplaryembodiments described herein and in any combination or grouping orarrangement. In particular, use of a single reference numeral herein toillustrate, define, or describe a particular feature does not mean thatthe feature cannot be associated or equated to another feature inanother drawing figure or description. Further, where two or morereference numerals are used in the figures or in the drawings, thisshould not be construed as being limited to only those embodiments orfeatures, they are equally applicable to similar features or not areference numeral is used or another reference numeral is omitted.

The foregoing description and accompanying drawings illustrate theprinciples, exemplary embodiments, and modes of operation of the systemsand methods. However, the systems and methods should not be construed asbeing limited to the particular embodiments discussed above. Additionalvariations of the embodiments discussed above will be appreciated bythose skilled in the art and the above-described embodiments should beregarded as illustrative rather than restrictive. Accordingly, it shouldbe appreciated that variations to those embodiments can be made by thoseskilled in the art without departing from the scope of the systems andmethods as defined by the following claims.

What is claimed is:
 1. A method of surgically cutting tissue with anultrasonic instrument that comprises an ultrasonic waveguide that ismovable along a longitudinal extent of the ultrasonic instrument, themethod comprising: compressing tissue between two opposing jaws disposedat a distal end of the ultrasonic instrument; applying a resonantultrasonic wave to the ultrasonic waveguide; and moving the ultrasonicwaveguide in a distal direction along the longitudinal extent to advancethe ultrasonic waveguide between at least a portion of the jaws to cutand seal the tissue temporarily secured between the jaws.
 2. The methodaccording to claim 1, wherein: the ultrasonic instrument comprises ahollow shaft having an internal lumen that defines a longitudinal axis;and the ultrasonic waveguide is slidably disposed within the internallumen of the shaft and is advanceable in the distal direction andretractable in a proximal direction parallel to the longitudinal axis.3. The method according to claim 2, wherein: the shaft has a proximalend; and the ultrasonic instrument further comprises a handle body atthe proximal end of the shaft, the handle body comprising a movementmechanism configured to advance and retract the ultrasonic waveguidealong the longitudinal extent of the ultrasonic instrument.
 4. Themethod according to claim 3, wherein the two opposing jaws comprise: afirst jaw fixed parallel to the longitudinal axis; and a second jawpivotally connected to the shaft and movable between open and closedpositions with respect to the first jaw such that compressing the tissuebetween the two opposing jaws comprises pivoting the second jaw towardsthe first jaw to move from the open position to the closed position. 5.The method according to claim 4, wherein the first jaw is one of fixedlyconnected to the shaft and integral with the shaft.
 6. The methodaccording to claim 4, wherein: the ultrasonic waveguide has a distalblade; the first jaw has a distal end defining a trough partiallyexposing the lumen to the environment; and which further comprisesadvancing the ultrasonic waveguide between at least a portion of the twoopposing jaws extends the distal blade into the trough.
 7. The methodaccording to claim 6, wherein: the distal blade has: proximal and distalends; a tissue compressing surface sloping upwardly from the distal endof the blade towards the proximal end of the blade and having an upperportion; and a substantially horizontal top surface at the upperportion, at least one of the tissue compressing surface and the topsurface forming a cutting surface; and responsive to the compressing ofthe tissue between the two opposing jaws and the advancing of theultrasonic waveguide between at least the portion of the jaws and intothe trough, the distal blade further compresses and cuts the compressedtissue.
 8. The method according to claim 4, wherein: the second jaw isconnected to the shaft by at least one pivot; and the ultrasonicinstrument further comprises a sheath surrounding the shaft andoperatively connected to the at least one pivot, the sheath beingconfigured to move relative to the shaft in the distal direction tocause the second jaw to move about the pivot towards the first jaw toassume the closed position.
 9. The method according to claim 3, whereinthe movement mechanism of the handle body comprises a trigger assemblyoperatively connected to the ultrasonic waveguide.
 10. The methodaccording to claim 3, wherein the handle body further comprises: anultrasonic transducer operatively coupled to the ultrasonic waveguide toimpart the resonant wave to the waveguide when activated; and a batteryconfigured to activate the ultrasonic transducer.
 11. A method ofsurgically cutting tissue with an ultrasonic instrument that comprisesan ultrasonic waveguide that is movable along a longitudinal extent ofthe ultrasonic instrument, the method comprising: applying a resonantultrasonic wave to the ultrasonic waveguide; and moving the ultrasonicwaveguide in a distal direction: to convert two opposing jaws disposedat a distal end of the ultrasonic instrument from an open position to aclosed position to compress tissue between the jaws; and to advance theultrasonic waveguide between at least a portion of the closed jaws tocut and seal the tissue compressed between the jaws.
 12. The methodaccording to claim 11, wherein: the ultrasonic instrument comprises ahollow shaft having an internal lumen that defines a longitudinal axis;and the ultrasonic waveguide is slidably disposed within the internallumen of the shaft and is advanceable in the distal direction andretractable in a proximal direction parallel to the longitudinal axis.13. The method according to claim 12, wherein: the shaft has a proximalend; and the ultrasonic instrument further comprises a handle body atthe proximal end of the shaft, the handle body comprising a movementmechanism configured to advance and retract the ultrasonic waveguidealong the longitudinal extent of the ultrasonic instrument.
 14. Themethod according to claim 13, wherein the two opposing jaws comprise: afirst jaw fixed parallel to the longitudinal axis; and a second jawpivotally connected to the shaft and movable with respect to the firstjaw such that converting the jaws from the open position to the closedposition comprises pivoting the second jaw towards the first jaw. 15.The method according to claim 14, wherein: the ultrasonic waveguide hasa distal blade; the first jaw has a distal end defining a troughpartially exposing the lumen to the environment; and which furthercomprises advancing the ultrasonic waveguide between at least a portionof the two opposing jaws extends the distal blade into the trough. 16.The method according to claim 15, wherein: the distal blade has:proximal and distal ends; a tissue compressing surface sloping upwardlyfrom the distal end of the blade towards the proximal end of the bladeand having an upper portion; and a substantially horizontal top surfaceat the upper portion, at least one of the tissue compressing surface andthe top surface forming a cutting surface; and responsive to thecompressing of the tissue between the two opposing jaws and theadvancing of the ultrasonic waveguide between at least a portion of thejaws and into the trough, the distal blade further compresses and cutsthe compressed tissue.
 17. The method according to claim 14, wherein:the second jaw has a ramp therein; and the ultrasonic waveguide has anupwardly-extending protrusion that is sized to engage with the ramp andplace a closing force on the second jaw as the ultrasonic waveguidemoves in the distal direction.
 18. The method according to claim 17,wherein the protrusion has an I-beam shape.
 19. The method according toclaim 13, wherein the movement mechanism of the handle body comprises atrigger assembly operatively connected to the ultrasonic waveguide. 20.The method according to claim 13, wherein the handle body furthercomprises: an ultrasonic transducer operatively coupled to theultrasonic waveguide to impart the resonant wave to the waveguide whenactivated; and a battery configured to activate the ultrasonictransducer.